Resolution No. 6722
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1 RESOLUT~~O.6722
2 A RESOLUTION OF THE CITY COUNCIL OF THE CITY
OF VERNON APPROVING REVISION NO. 1 TO CITY OF
3 VERNON SAFETY PROGRAM, APRIL, 1991
4 WHEREAS, the City of Vernon, by Resolution No. 5925 on
5 May 21, 1991, approved the City of Vernon Safety Program; and
6 WHEREAS, the City's Safety Committee has reviewed said
7 Program and recommended certain revisions to guarantee that the
8 City's program will provide effective injury prevention and will
9 be consistent with the methods and procedures currently used.
10 NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF
11 THE CITY OF VERNON AS FOLLOWS:
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SECTIO~ 1: The City Council of the City of Vernon
13 hereby finds and determines that the recitals contained
14 hereinabove are true and correct.
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SECTION 2: The City Council of the City of Vernon
16 hereby approves Revision No. 1 to City of Vernon Safety Program, a
17 copy of which has been presented to the City Council concurrently
18 with this resolution.
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SECTION 3: The City Council hereby orders said Revision
20 No. 1 to be received and filed by the City Clerk.
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SECTION 4: The City Clerk of the City of Vernon shall
22 certify to the passage of this resolution, and thereupon and
23 thereafter the same shall be in full force and effect.
24 APPROVED AND ADOPTED this 5th day of December, 1995.
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AT~:
BRUCE V.
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STATE OF CALIFORNIA )
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COUNTY OF LOS ANGELES )
I, BRUCE V. MALKENHORST, City Clerk of the City of
Vernon, do hereby certify that the foregoing Resolution, being
Resolution No. 6722, was duly adopted by the City Council of the
City of Vernon at a regular meeting of the City Council duly held
on Tuesday, December 5, 1995, and thereafter was duly signed by
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the Mayor of the City of Vernon.
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BRUCE V. MALKENHORST, C1ty Clerk
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(SEAL)
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CITY OF VERNON
SAFETY PROGRAM
APRIL, 1991
REVISED DECEMBER 1993
REVISED DECEMBER 1994
REVISED SEPTEMBER 1995
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Chapter I
Chapter II
Chapter III
Chapter IV
Chapter V
Chapter VI
Chapter VII
Chapter VIII
SAFETY PROGRAM
TABLE OF CONTENTS
PAGE
INTRODUCTION 1
Safety Policy,Procedures,Organization,
Responsibilities
ADMINISTRATIVE PROCEDURES 5
Generalized' Procedures,
CAL/OSHA Requirements
.:.
SAFETY COMMITTEE 7
Committee Organization, Meeting Procedures,
Activities,Tailgate Meetings
SAFETY INSPECTION 10
Procedures for Locating and Eliminating
Possible Hazards,Exhibit A - Report of
Safety Problem
WORK-RELATED INJURY/ILLNESS 12
Job Injury Procedures,Modified Work, Lost
Time,Follow-up Visits, Physicians, Treatment
Facilities,Reporting Requirements,EXhibit
B-DWC Form 1,Exhibit C - On the Job Injury
Log,Exhibit D - Supervisor'S Report of
Accident,Exhibit E - Form 5020
ACCIDENT INVESTIGATION AND ANALYSIS 16
Checklist for Identifying Key Factors,
Employer Level Investigation
AUTOMOTIVE ACCIDENTS 21
Accident Procedures,Accident Investigation
Committee, Exhibit F - AIC,Exhibit G - AIC
Findings and Recommendations
SAFETY AND HEALTH ENFORCEMENT 22
Safety Counseling,Work Practice Enforcement
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Chapter IX
Chapter X
Chapter XI
Chapter XII
Chapter XIII
OPERATIONS IN THE PUBLIC WAY 23
Traffic controls/Barricades, Pedestrian
Safety
SAFETY TRAINING 25
Job Safety Analysis (JSA) and Job-
Instruction Training (JIT),Exhibit H -
J.S.A. Sample, Exhibit I - J.S.A. Form
SAFETY REGULATIONS 28
Principal Causes of Accidents, General Safety
Rules,Office Safety, clothing and Equipment,
Material Handling,Electrical,Housekeeping,
Automotive,Ladders and Platforms, Pneumatic
Tools,Burns and Welding,Chemicals,
Excavations,Street repairs, Sub-Surface
Operations, and Confined Spaces
HAZARDOUS MATERIALS 40
Contingency Plan, Training Plans, Supervisor
Guidelines,Training Documentation,Exhibit
K-Hazard Communication Program Forms
EMERGENCY PREPAREDNESS
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CHAPTER I
INTRODUCTION
SAFETY POLICY
The purpose of this outline is to establish general methods and
procedures for developing and maintaining a program of 'accident
prevention throughout the operations of the City of Vernon.
In carrying out these purposes, this program has as its specific
objectives the prevention of physical injury,disability,sickness,
loss of work, fatalities and destruction or damage to property of
the city. As an additional objective, it also includes the
prevention of accidents involving the citizens or prope+ty within
the City of Vernon. ~
A common and sympathetic interest exists between the City's
management an,d employees in the maintenance of an adequate and
effective accident prevention program. The promotion of this
common interest is furthered and extended through close
cooperation.
The procedures that follow anticipate that such cooperation will be
established and maintained at all times between management, its
employees and employee associations.
PROCEDURES
The general procedures to be followed are divided into three parts
as follows:
1. Eliminate unsafe structures,installations,working conditions,
acts of individuals, and unsafe automotive and other equipment.
2. Organize and supervise a program of safety information and
training among the employees to ,teach:
a. The correct use of tools and equipment.
b. Safe work methods.
c.- Safety precautions.
d. Application of safety rules for accident prevention.
e. Proper use of safety devices.
f. Safety orientation of new employees.
3. Maintain records of accidents and safety performance.
,Investigate and qnalyze all accidents,prepare reports for
management and submit recommendations for preventative
measures.
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ORGANIZATION
The organization of the safety program utilizes all existing
channels of authority within the City of Vernon. In addition to
these established channels, a supplementary organization has been
set up with specific responsibilty for the safety program as
follows:
Risk Manaqer. The Risk Manager is the safety officer and
serves under the direction of the City Administrator in all
functions in connection with this program. The Risk
Manager shall serve as an advisor to the Safety Committee.
Safety Coordinator. Safety Coordinators will be department
safety representatives. They will be responsible for
reporting unsafe conditions to their respective Department
Heads and the Risk Manager. .
Safety Committee. The Safety Committee will consist of the
Risk Manager,and Safety Coordinators. The Committee will
be responsible for the overall operation of the safety
program. The Safety Committee shall meet once each month
at a regularly scheduled date and time.
Tailqate (department) Meetinqs. These meetings will
provide the Safety Coordinator with the opportunity to
impress upon personnel the necessity of making accident
prevention an essential part of the job. Tailgate meetings
shall be held biweekly at a regularly scheduled date and
time as mandated. If not mandated, Tailgate meetings may
be held as needed.
RESPONSIBILITIES
Risk Manager
The Risk Manager is responsible for the development, organization,
coordination and implementation of safety programs and safety
education. Responsibilities also include work site inspections,
hazard reduction and/or elimination, accident/injury
investigation, reporting and management.
The Risk Manager will advise the City Administrator as well as
Department Heads, supervisors and employees of unsafe
conditions, problems related to accident prevention and
recommendations for loss control. The Risk Manager will not
fulfill obligations of administrators or supervisors relative to
providing safe work environments, necessary equipment, training as
w~ll as inspections in the interest of accident prevention. The
: Rlsk Manager will prepare a monthly loss analysis report to the
City Administrator,City Council and Department Heads.
Rev. 12/94
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Department Head
The Department Head is responsible for fulfillment of departmental
goals and objectives as well as health and welfare of each employee
in the department. In the adopted safety policy, the highest
priority has been placed on employee safety, which, therefore becom~s
the responsibility of the respective administrator. It is normal
practice for supervisors to be delegated the authority to carry out
safety policy in his or her departmentibut the responsibilty for
meeting objectives and the protection of employees in performance
of their assignments cannot be transferred.
SUPERVISOR
Supervisors will assume the responsibility of -':horoughly
instructing their personnel in the safe practices to be Observed in
their work situations. They will consistently enforce safety
standards and requirements to the utmost of their ability. and
authority. Supervisors will act positively to eliminate any
potential hazards within the activities under their jurisdiction
and they will set the example of good safety practice in all
spheres of their endeavors. The principal duties of supervisors in
discharging responsibilities for safety are as follows:
A. Enforce all safety regulations in effect and make employees
aware that violations of safety rules will not be tolerated.
B. Make sure all injuries are reported promptly and all accidents
are reported even if injury is not apparent.
C. Conduct thorough investigation of all accidents and take
necessary steps to prevent recurrence through employee safety
education, operating procedures or modification of equipment.
D. Provide employees with complete safety instructions regarding
their duties prior to the employee actually starting to work.
E. Conduct regular safety checks of the area, including a careful
examination of all new and relocated equipment before it is
placed in operation.
F. Properly maintain equipment and issue instructions for the
elimination of fire and safety hazards.
G. Continuously inspect for unsafe practices and conditions and
promptly undertake corrective action.
Hi ,Develop and administer an effective program of good
housekeeping and maintain high standards of personal and
operational cleanliness throughout all operations.
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I. Provide safety equipment and protective devices for each job
based on knowledge of applicable standards or on recommendation
of the Department Head and/or Risk Manager.
J. Conduct tailgate meetings for safety education at biweekly
intervals, allow discussion period for employees to express
their concerns, ask questions, etc.
K. Give full support to all safety procedures, activities and
programs.
EMPLOYEE
Each employee,as part of the comprehensive safety' and loss
prevention program,is expected to place safe work practices and
identification of unsafe conditions in their highest priority while
performing their daily tasks. Each employee's safety commitment
must include,but is not limited to the following:
A. Using the safety equipment which has been provided in
performing his daily work assignments.
, B. Wearing the prescribed uniform and safety shoes as required.
Wearing any and all safety apparatus as required by the job.
C. Not operating equipment or using tool for which training or
orientation has not been received.
O. Warning supervisors and co-workers of unsafe conditions or
practices they are engaged in which could lead to or cause an
accident.
E. Reporting defective equipment, including vehicles, immediately
to a supervisor and filing repair orders per departmental
policy.
F. Reporting dangerous or unsafe conditions that exist in the work
place as well as throughout .the city. Thi~ would include
defective sidewalks, broken curbs, hanging limbs, loose handrails,
open manholes, sunken basins and sewers,missing signs, etc.
G. Reporting of all injuries and accidents regardless of severity.
H. Taking care not to abuse tools and equipment,so that these
items will be in usable condition for as long as possible as
well as to ensure that they are in the best possible condition
'while being used~
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Rev. 12/94
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CHAPTER II
ADMINISTRATIVE PROCEDURES
Under the direction of the Risk Manager,administrative procedures
shall be established for the following:
1. The Safety Committee shall meet once each month. Meeting date
and time may be changed by a consensus of the committee but no
less than one meeting each month is required.
2. Department Heads will allocate time for their Safety
Coordinators to conduct Tailgate meetings within their
departments. These meetings will be conducted bimonthly.
3. A written record of the minutes of the Safety Committee and
department or unit safety meetings shall be made. A copy of
such minutes will be made and -forwarded to Risk Mana~ement.
4. Prompt written response of action(s) taken on reports from
Risk Management and/or recommendations submitted by the Safety
Committee.
5. Effective accident investigation.
6. Action against individual violators of safety rules and
practices.
7. Safety training programs for employees and supervisory
personnel.
8. Complaints from employees concerning a possible injury or
illness potential.
9. Inspections,audits and a periodic review of all premises,
equipment and materials. Recommendations may be categorized
as follows:
a. Immediate Action - those items which pose imminent danger
or which require only modest expenditures of time and
material, and can be accomplished by the person having
direct responsibility.
b. As Soon As possible - those items which require the
assistance of another department, routine maintenance
items, hazards which may lead to possible serious injury
and those requiring a modest expenditure of time and money.
! c. As Schedule Permits - those items which are temporarily
acceptable but will require correction.
Rev. 12/94
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d. pre-planninq Necessary - recommendations requiring new
programs, equipment or process.
DOCUMENTATION
Action on any of the above shall be documented in all in3tances.
CAL/OSHA POSTING. REPORTING AND RECORD KEEPING REOUIREMENTS
1. Postinq Requirements
CAL/OSHA poster must be posted in a prominent place. This
poster states the intent and coverage of CAL/OSHA and the
responsibilities of employers and employees to maintain a safe
and healthful working environment.
2. Reportinq
All fatal accidents, catastrophes involving five or more
employees and serious injuries requiring hospitalization for
more than 24 hours must be reported to the nearest office of
the Division of Industrial Safety immediately,and in no case
more than 24 hours (Pico Rivera, (310) 949-7827).
3. Record Keeping
Records shall be made and maintained in accordance with
CAL/OSHA requirements. The official records will be kept by
the Risk Manager.
4. Inspections
The CAL/OSHA inspector usually will arrive unannounced. Refer
the inspector to the Risk Manager.
Rev. 12/93
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CHAPTER III
SAFETY COMMITTEE
COMMITTEE ORGANIZATION
Representation on the Safety Committee shall be as follows:
1. All City departments will be represented by a Safety
Coordinator.
2. Committee members shall serve for two years or until replaced
by the Department Head.
3. The Risk Manager may be the Chairperson.
. 4. One of the committee persons may be designated-as vice-
chairperson who will chair the meetings in the absence of the
chairperson.
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5. Chairperson may appoint a secretary to record the minutes of
the meetings.
6. Chairperson may appoint sub-committees and members as
required with approval of the City Administrator.
MEETINGS
The Safety Committee shall meet monthly at a regularly scheduled
date and time. Meetings should not extend beyond one and on-half
hours and should normally be of one hour duration or less depending
on the business to be conducted.
COMMITTEE MEETING PROCEDURES
Committee meeting procedures are as follows:
1. Start of meeting - Chairperson (date and time).
. 2. R~ll call - record members present and absent.
3. Introduction of visitors,if any.
4. Review minutes of previous meetings and approve or amend.
5i ,Unfinished busin~ss (reports from committees).
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6. Review of accidents and recommendations to prevent recurrence.
Rev. 12/93
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7. New business (recommendations,suggestions,hazardous
situations).
8. Other business,if any.
9. Announcement of next meeting, date, time and place.
10. Adjourn meeting (time).
SCOPE OF COMMITTEE ACTIVITIES
The Safety Committee recommends matters of policy such as training
needs and methods, safety equipment,rules and practices, etc. They
may review accident reports and statistics; and project future
plans for the advancement of the safety program through" the basic
elements: engineering, education and enforcement.
SUB-COMMITTEES
A. Accident Investiqation Committee (AIC) - the committee is
comprised of the Risk Manager,a designated employee by the
City Administrator and a designated management employee from
the department in which the accident occurred. The AIC will
convene no later than 2 weeks after the accident. The
Department Head shall inform the involved employee of the date
and time of the AIC meeting. The involved employee has the
right to attend the AIC meeting. If the employee does not
choose to attend the AIC meeting he must waive this right in
writing to the Department Head.
B. Safety Awards Committee - reviews employee safety suggestions
and determines awards given per Committee policy.
C. Safety Education Committee - responsible for the educational
development and generalized safety programming of all
employees.
D. Safety Inspection Committee - responsible for the coordination
of City-wide annual and specialized inspections. This
committee may function at the department level.
SUPERVISOR'S INJURY REPORTS
The Accident Investigation Committee will review every
i~jury/accident and recommend action to prevent recurrence, whenever
!possible. A copy of'the recommendations will be forwarded to the
a~fected Department Head and City Administrator for further action.
Rev. 12/93
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RECOMMENDATIONS. SUGGESTIONS AND HAZARDOUS SITUATIONS
Committee members are encouraged to bring all safety matters to the
attention of the affected Department Head for correction prior to
being brought up at a Committee meeting.
Every recommendation, suggestion or reported hazardous situation
shall be assigned for action and report to that Committee person
where the situation exists. However,there may be 'situations when
the Chairperson may have to contact management on a particular
problem or where the services of the Risk Manager may be required.
In no case shall new business be brought up and recorded without an
assignment of responsibility.
The Safety Committee person who has been assigned a project will do
the necessary research and/ or contact the Department Head for
appropriate action.
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CHAPTER IV
SAFETY INSPECTION
a. Purpose
The purpose of this part of the program is to eliminate unsafe
structures,installations,working conditions and equipment.
B. Procedures for Locatinq Hazards
1. Periodic inspections will be conducted to recognize and
correct unsafe working conditions, acts and environmental
hazards on or about facilities of the city,as f91lows:
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a. Supervisors must maintain a continuous visual
inspection "of locations,equipment,tools,personal
protective devices and working conditions under their
supervision.
b. Safety Coordinators will conduct periodic inspections
of departments they represent.
c. Employees will report all possible hazards and/or
safety problems to the supervisor.
d. The Risk Manager may inspect facilities and working
conditions and submit his/her findings and
recommendations to management.
C. Procedure to Eliminate or Correct Hazards
1. The supervisor responsible makes corrections whenever it is
within his authority to do so.
2. If corrections are beyond the authority of the supervisor
responsible,he prepares a request for correction and
submits it through established channels for approval.
3. In the event the recommended corrections are of an urgent
nature, verbal approval is obtained from the proper
authority,followed by the written request for approval.
4. If correction cannot immediately be made and danger to
human life and property is imminent, the equipment will be
taken out of service and "tagged" to prohibit its use or
the operation will be stopped until such time as the hazard
is either removed or corrected.
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5. If the possible hazard and/or problem does not pose an
imminent danger to human life or property,the employee
shall:
a. Notify the supervisor of the problem.
b. Complete the "report of Safety Problem" form:
(Exhibit A)
c.
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EXHIBIT A
NO.
City of Vernon
Report of Safety Problem
To:
Supervisor
From:_... _
Employee
DATE:
Received by:
Signature of person receiving report
DATE:
c.
The purpose of this report is. to solve the safety problem at the first level of notice. Therefore,
the report is to be submitted to the employee's immediate supervisor.
Description of problem (include exact location)
Action taken:' (to be completed by immediate supervisor)
~n corrected Supervisor Sign:
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Date:
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When safety problem corrected:
Copy to Department Head
Copy to reporting employee
WPP/REPT .SAP
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CHAPTER V
WORK-RELATED INJURY/ILLNESS
PROCEDURES - TIME OF INJURY
1. Report the injury to your supervisor immediately. If the
injury is serious and no supervisor is present, get medical
attention first.
2. Secure approval from your supervisor, the department head, or
administration office.
3. Medical Service Order form must be completed by physician
and returned to supervisor.
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MODIFIED WORK
1. If restrictions are placed upon the injured employee, the
treating physician shall notify administration of said
restrictions either by phone or in writing.
2. If the supervisor determines that no modified work assignment
is available, the employee shall remain off work until one
becomes available or released to full duty.
3. Employees are responsible for notifying their supervisors prior
to any absence from home beyond two days.
4. Modified work assignments are the responsibility of the
department head and supervisor.
LOST TIME
1. The treating physician must authorize all time off from work.
The certification of time off may be subject to concurrence by
a City physician.
2. It is the employee's responsibility to return doctor's notes
fo~ all time off. Any time off not supported by documentation
shall be charged against the employee's benefit time
(i.e.,vacation,comp.time,etc.) or considered unpaid leave at
the discretion of the City Council.
Rev. 12/94
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FOLLOW-UP VISITS
1 Employees are required to attend all scheduled follow-up
visits.
2. If an appointment cannot be kept,it is the employee's
responsibility to cancel and/or reschedule a minimum of
24 hours in advance.
3. Failure to comply with the above may result in a monetary
expense to the employee if it is charged to the city by the
treating physician.
PHYSICIANS
1. Employees should be treated at TechniMed Vernon Center unless
an Industrial Injury Physician Designation Form is on file in
the employee's personnel file.
2. In the event of serious injury the employee should go to the
nearest medical facility.
TREATMENT FACILITIES
TechniMed Vernon
3364 E. Slauson
Vernon, CA 90058
EXTREME EMERGENCIES
White Memorial Hospital
414 N. Boyle Avenue
Los Angeles, CA
REPORTING REQUIREMENTS
1. If an employee is injured on the job beyond first aid give
him/her DWC Form 1 (1-1-90) Employee's Claim For Workers'
Compensation Benefits within 24 hours of date you are informed.
This may be handed to the employee or mailed regular mail but
must be done within 24 hours of date you learn he/she has been
injured. (See sample at end of this section,Exhibit B.)
Rev. 12/93
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2. Complete the On The Job Iniury Loq indicating employee's name,
injury date,date you were informed of the injury,date you
provided the DWC Form l,date the DWC Form 1 was returned to you
and the employee's signature that he/she did receive the DWC
Form 1. If employee is unavailable to sign for the form, the
supervisor may sign indicating that employee is unavailable.
(See sample at the end of this section,Exhibit c.)
3. Complete the Supervisor's Report of Accident.
the end of this section,Exhibit D.)
4. Employer's Report of Occupational Injury or Illness (Form
5020). Complete this form only if the injury is other than
first aid. If in doubt, complete Form 5020 and send to Risk
Management. Risk Management will make the determination.
(See sample at the end of this section,Exhibit E.)
(See sample at
Complete Form 5020 as follows:
#1 Thru #5 are always the same.
#6 Full name of injured employee.
#7 Injured employee's date of birth.
#8
Injured employee's home address (NOT EMPLOYER'S ADDRESS).
This is because certain documents (checks,doctor's
appointments,etc.) are sent directly to the injured
employee. If the City'S address is used, these documents
may not get to the employee within the necessary time
frame.
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#8A Injured employee's home telephone number. Include area
code.
#9 Injured employee's sex.
#10 Injured employee's classification (i.e. utilityman III,
DieseIOperator,etc.).
#11 Injured employee's social-Security number.
#12 City department to which injured employee is assigned,
plus department number (i.e. Community Services-
Engineering/Planning 1040; Fire 1033; etc.)
#13 Hours usually worked.
#14 Gross monthly wages (if unknown, check with Finance-
Payroll). If hourly employee,give hourly wage rate.
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Rev. 12/94
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#15 Give address where injury occurred.
#15A Los Angeles County.
#15B If injury actually occurred on City property,answer
"Yes".
If injury occurred elsewhere (i.e. public street,
private residence,etc.) answer "No." -
#16 Explain what injured employee was attempting to do when
injury occurred.
#17 Specifically state the HOW and WHY of how the injury
occurred.
#18 specifically state what object injured or caused injury
to employee.
#19A What kind of injury did employee complain of.
#20 Name,street address,city and state of first treating
physician.
#20 Name,street address,city and state of hospital,if
employee was hospitalized.
#22 Calendar date of injury.
#23 Time of day.
#24 If employee was under doctor's orders not to return to
work the answer is "Yes" and give the date last worked.
If employee was returned to work immediately,the answer
is "No."
#25 If __employee has returned to work the answer is "Yes" and
give the date returned.
If employee is still under doctor's orders not to return
to work at time this form" is completed,the answer is
"No."
#26 If employee died due to this injury,the answer is "Yes"
and give date.
If employee did not die,answer is "No."
NOTE: In cases of employee death, Risk Management must
be notified immediately as this must be reported
to the State within 24 hours.
Completed by: Signature; Title and Date.
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This form Must be completed by the injured employee's supervisor.
REPORTING REQUIREMENTS FOR FIRST AID INJURIES
Injuries where there is no lost time beyond the date of injury
or the injury requires no medical treatment beyond first aid.
1. Complete the Supervisors Report of Accident. Exhibit D
2. Complete the 5020 form discussed on pages 14 and 15.
Exhibit E
3. Send both forms to Risk Management.
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Rev. 9/95
State Of California
Department of Industrial Relations
blVISION OF WORKERS' COMPENSATION
EMPLOYEE'S CLAIM FOR
WORKERS' COMPENSATION BENEFITS
If you are injured or become ill because of your job, you are
entitled to workers' compensation benefits.
Complete the "Employee" section and give the form to your
employer. Keep the copy marked "Employee's Temporary Receipt"
until you receive the dated copy from your employer. You may
contact the State's Office of Benefit Assistance and Enforcement
at 1-800-736-7401 if you need help in filling out this form or in
obtaining your benefits. An explanation of workers' compensa-
tion benefits is included on the reverse of this form.
You should also have received a pamphlet from your employer
describing workers' compensation benefits and the procedures
to obtain them.
An~ person \\ ho makes or tauses to be made am kn()\\ ingh
false or fraudulent material statement or material repre-
sentation for the purpose of obtaining or den~ ing \\orkers'
lOmpensation benefits or p.wments is guill\ of felonv.
Employee: Empleado:
1. Name. Nombre.
2. Home address. Direcci6n Residencial.
3. City. Ciudad.
4. Date of injury. Fecha de la lesi6n (accidente).
EXHIBIT B
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Estado de California
Departamento de Relaciones Industriales
DIVISION Df COMPfNSACION AL TRABAjADOR
RECLAMO DEL EMPLfIoDO PARA BENEFICIOS
DE COMPENSACION DEL TRABAJADOR
Si Ud. se ha lesionado 0 se ha enfermado en/o a causa de su
trabajo, Ud. tiene derecho a recibir beneficios de compensaci6n
al trabajador.
Complete la secci6n "Empleado" y entregue la forma a su
empleador. Quedese con la copia designada "Recibo Temporal
del Empleado" hasta que Ud. reciba la copia fechada de su
empleador. Si Ud. necesita ayuda para completar esta forma 0
para obtener sus beneficios, p6ngase en contacto con la Oficina
Estatal de Asistencia para Beneficios y fjecuci6n de las Leyes
Pertinentes lIamando all-BOO-736-7401. AI dorso de esta forma
se encuentra una explicaci6n de los beneficios de compensaci6n
al trabajador.
Ud. tambien deberla haber recibido de su empleador un
tol/eto describiendo 105 beneficios de compensac16n al tra-
bajador lesionado y los procedimientos para obtenerlos.
Toda aquell.l persona que ton tonodmiento haga 0 C.luse
que se produlla cualquier declaracion 0 rl'presentation
material fal5a 0 iraudulenta con el fin de obtener 0
negar henefitios 0 pagos de compensacion .I trabaj.l-
dores lesionados es tulpable de un crimen mayor "feloni.l."
Todays Date. Fecha de Hay.
State. Estado.
Zip. C6digo Postal.
Time. of injury. Hora en que ocurri6
a.m.
p.m.
5. Address/place where injury happened. Direcci6nllugar donde ocurri6 el accidente.
6. Describe inj~ry and part of body affected. Desc~iba la lesi6n y/a parte del cuerpo afectada.
7. Signature of employee. Firma del empleado.
Employer -complete this section and give the employee a copy immediately as a receipt.
EmpleadOl'-complete esta secci6n y dele inmediatamente una copia al empleado como recibo.
8. Name of employer. Nombre del empleador.
Address. Direcci6n.
9. Date employer first knew of injury. Fecha en que el empleador supo por primera vez de la lesi6n 0 accidente.
10. Date claim form was provided to employee. Fecha en que se Ie entreg6 al empleado la petici6n.
11. Date employer received claim form. Fecha en que el empleado devolvi6/a petici6n completada al empleador.
12. Name and address of insurance carrier or adjusting agency. Nombre y direcci6n de la compaflla: de seguros 0 agencia administradora
de seguros.
14. Title.. fifo/a.
15. Tele
13. SignaturE( of t;mployer representative. Firma del representante del empleador.
,
o:mployer: You are required to date this form and provide copies to your
insurer and to the employee. dependent or representative who filed the
claim within one working day of receipt of completed form from employee.
SIGNING THIS FORM IS NOT AN ADMISSION OF LIABILITY
Original (Employer's Copy)
OWC Form 1 (REV. 4193)
hone. Telefono.
Empleador. Se requiere que Ud. feche esta forma y que provea
copias a su compan/a de seguros y empleado, dependiente 0
representante que haya presentado esta petici6n dentro del plazo
de un dia habil desde el momento de haber side recibida la forma
completa del empleado.
EL FIRMAR ESTA FORMA NO SIGNIFICA ADMISION DE
RESPONSABILlDAD
Original ICopia del Empleador)
OWC Forma , (REV. 4/93)
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EXHIBIT D
CITY OF VERNON
SUPERVISOR'S REPORT OF ACCIDENT/EXPOSURE
Name of injured
2. Department
3. Address where accidenVexposure occurred
Job title
Sex: M F
Supervisor
4. Wh~t was employee doing when injured?
5. Names of witnesses?
6. How did accidenVexposure occur?
c.
7. If exposure, product/chemical involved?
Duration of exposure:
hours
minutes
seconds
unknown
~. Object or substance that directly injured employee?
~J O. Nature of injury.orJllness ClI'!~ ~ o! body affected
" ,-.;:;;p, -'~;.:c_, -:,,,
11... Date of injury/illness/exposure
Time
,i12. Has employee returnec.t to Work?
-.r13. Who gave first aid, if any?
,14. Did employee go to the doctor? _YES
YES, date returned .
NO, still off work
NO ' If yes,-name of doctor or clinic
15. Did the employee commit an unsafe act? Explain
16. Explain factors that could have contributed to the accident (Improper attitude, physical Impairment I.e., eyesight, hearing, fatigue,
etc., or lack of knOwledge or skill>
i .
17. What hav~ yOu personally done to prevent similar accidents?
EMPLOYEE
DATE
SUPERVISOR
DATE
DEPARTMENT HEAD
DATE
..ft:.
Exhibit E
. State of California
Please complete in triplicate (type. if possible). Mail two copies to:
OSHA
Case No.
EMPLOYER'S REPORT
QF OCCUPATIONAL
'URY OR ILLNESS
I
COLEN AND LEE
1470 Soulh Valley Vista Drive. Suite 230. Diamond Bar. CA 91765
Risk Management Services (909) 861-0816
D Fatality
Any person who makes or causes to be made any
knowingly false or fraudulent material statement
or material representation for the purpose of
obtaining or denying workers' compensation
benefits or payments is guilty of a felony.
NOTICE: California law requires employers to report within five days of knowledge every occupational injury or illness
which results in lost time beyond the date of the incident OR requires medical treatment beyond first aid. If an employee
subsequently dies as a result of a previously reported injury or illness, the employer must file within five days of
knowledge an amended report indicating death. In addition, every serious injury/illness, or death must be reported
Immediately by telephone or telegraph to the nearest office of the California Division of Occupational Safety and Health,
1. FIRM NAME
lA. POLICY NUMBER
DO NOT USE
THIS COlUMN
E 2. MAILING ADDRESS (Number and Street, City. ZIP)
M
P
L
o
y
E
R
2A, PHONE NUMBER
Case No.
3. LOCATION, tF DIFFERENT FROM MAILING ADDRESS (Number and Street. C~y. ZIP)
3A. LOCATION CODE
Ownership
4. NATURE OF BUSINESS. e.g.. painting contractor. wholesale grocer. sawmill. hotel. ete.
5. STATE UNEMPLOYMENT INSURANCE ACCT. NO.
Industry
6. TYPE OF EMPLOYER
o PRIVATE 0 STATE 0 CITY 0 COUNTY 0 SCHOOL DIST.
7, EMPLOYEE NAME
Occupation
o OTHER GOVERNMENT. SPECIFY
8. SOCIAL SECURITY NUMBER
9. DATE OF BIRTH (mm1dd1yy)
Sex
E
M
P
L
o
y
E
E
10. HOME ADDRESS (Number and Street, C~y. ZIP)
lOA. PHONE NUMBER
Age
11. SEX
o MALE 0 FEMALE
14. EMPLOYEE USUALLY WORKS
hours days
per day per week
15, GROSS WAGEStSALARY
$ per
)17. DATE OF INJURY OR ONSET OF ILLNESS
(mm/ddlyy)
12. OCCUPATION (Regular job t~I&-NO initials. abbreviations or numbers)
13. DATE OF HIRE (mm1dd1yy)
Daily hours
total
weekly hours
14A. EMPLOYMENT STATUS (check applicable status at time 01 injury)
regular .
Iull,time part-time temporary seasonal
16. OTHER PAYMENTS NOT REPORTED AS WAGES/SALARY (e.g., tips, meals. lodging.
DYES, $ per 0 NO
19. TIME EMPLOYEE BEGAN WORK 20. IF EMPLOYEE DIED, DATE OF DEATH
A.M. P.M, (mmldd/yy)
14B. Under what Class code of your
policy were wages assigned?
Days per week
Weekly hours
Weekly wage
21. UNABLE TO WORK FOR AT LEAST ONE FULL DAY
AFTER DATE OF INJURY? 0 YES 0 NO
25. PAID FULL WAGES FOR DAY OF INJURY OR-
23. DATE RETURNED TO WORK
(mm/dd/yy)
County
o
Nature of injury
Part of body
I
N
J
U
R 31. DEPARTMENT WHERE EVENT OR EXPOSURE OCCURRED. e.g., shipping department, machine shop.
y
30. lOCATION WHERE EVENT OR EXPOSURE OCCURRED (Number, Street. C~y)
3OA. COUNTY
3OB. ON EMPLOYER'S PREMISES?
DYES oNO
Source
Event
o 33. EQUIPMENT, MATERIALS AND CHEMICALS THE EMPLOYEE WAS USING WHEN EVENT OR EXPOSURE OCCURRED, e.g., acetylene, welding torch, farm tractor, scaffold.
R
See. Source
34. SPECIFIC ACTIVITY THE EMPLOYEE WAS PERFORMING WHEN EVENT OR EXPOSURE OCCURRED, e.g., welding seams of metal forms. loading boxes onto truck.
Extent of injury
I
L
L
N
E
S
S
35, HOW IN./URYIILLNESS OCCURRED. DESCRIBE SEOUENCE OF EVENTS. SPECIFY OBJECT OR EXPOSURE WHICH DIRECTlY PRODUCED THE INJURY/ILLNESS, eg., worker stepped back
to inspect work and slipped on scrap material. As he left, he brushed against fresh weld. and burned right hand. USE SEPARATE SHEET IF NECESSARY.
36. NAME AND 1DDRESS OF PHYSICIAN (Number and Street, City. ZIP)
36A. PHONE NUMBER
37. IF HOSPITALIZED AS AN INPATIENT. NAME AND ADDRESS OF HOSPITAL (Number and Street. C~y. ZIP)
37A. PHONE NUMBER
Completed by (type or print)
Signature
Title
Date
FORM 5020 (REV. 6)
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CHAPTER VI
ACCIDENT INVESTIGATION AND ANALYSIS
ACCIDENT INVESTIGATION
Good accident investigation starts long before the accident happens
and ends after the accident occurred. WE MOST KNOW THE CAUSE IF WE
WANT TO CORRECT THE PROBLEM. If we use a step-by-step guideline
process, investigations can be effective. First,look at the steps
to accident investigation:
1. You must clearly understand the need to investigate
2. You must be prepared to do the investigation
3. Gather all the facts about the accident
4. Analyze the facts you gathered
5. Based on facts, develop your conclusions
6. Then analyze the conclusions
7. Document conclusions in a report
8. Make specific recommendations to get action
9. Sell your recommendations to get action
10. FOllow-up on the recommendations to get compliance
11. Then critique your whole investigation
12. Follow-up again in the corrective action
Usually accident investigation only involves gathering facts about
the accident and making conclusions. This is not enough. An
investigator must get the big picture and prevent reoccurrences.
.THE STEPS ARE:
1. THE NEED: Do you really want to prevent further accidents? Or
are you just going through the process?
2. PREPARATION: If you wait until the accident happens it is too
late for prepara~ion. You need a pre-plan to follow and a few
tools. The pre-plan should be short and only cover a few
things.
17
YOUR PROGRAM SHOULD INCLUDE:
1. Prompt accident reporting system to let certain people know
immediately.
2. Get emergency people to the scene as soon as possible.
3. Procedures to preserve evidence at the accident site.
4. Notify the investigator immediately.
The investigator should arrive at the scene prepared with procedure
checklist, pen, paper, camera, tape, and proper clothing.
GATHER FACTS:
c-
When you go to the accident scene, expect to go to work, follow your
pre-plan~ Evaluate what you see as you approach the accident site.
Look around to locate things and people, glance at scattered debris.
I f nobody' s in charge, take charge unt i 1 someone can take over.
Medical attention comes first, then evaluate how large the area. is.
It really helps when you are organized and going in the right
direction. Pick-up debris evidence that might be swept up
later,get phone numbers of witnesses and call them later when you
have the time, take photos from all angles, make sketches and take
measurements. After you leave the accident site, examine
records, procedures, etc. Talk to all the witnesses. If you are
organized and follow the pre-plan, you will gather a lot of fact
information.
ANALYZING THE FACTS:
You have already mentally weighed the facts as you covered
them, weigh all witness statements for credibility and how they
support . the evidence. Include analysis of all facts
gathered, including management and supervision procedures. As you
analyze the facts search for more facts and contributing factors.
DOCUMENT EVERYTHING. This will help, to get the big picture.
CONCLUSIONS:
Start ~o reach conclusions about what happened and what caused the
accident. Write a statement on conclusions then turn back to
analysis.
ANALYSIS:
Th~s, step was ongoing up to now and has not really stopped.
Ne~t,get any additional information that you might need and analyze
or discard it.
18
THE REPORT:
This is where you put it together. You gathered information from
the beginning to the end. You've analyzed it and reached
conclusions. start by just briefly telling what happened in
narrative style, such as:
"On September 20,1990,at 8:15 AM,in the Public Works Yard,
a hydraulic 10-ton jack was being used to remove the dual
rear wheels. The mechanic was seriously injured".
When you tell the story leave out information that will not
contribute to your conclusions. Make recommendations that are
supported in the report. Your report needs to be clear and
concise. The reader must understand what happened. Do not include
anything that is not needed. Pictures and diagrams must 'contribute
meaning to the report,if not, leave them out.
RECOMMENDATIONS:
The investigation is not done when the conclusions are made to the
cause of the accident~ Corrective action must be taken. Specific
recommendations are needed for each cause factor or situation.
This way management can easily determine who's responsibility it is
to take corrective action. The best way, is to hold one person
accountable for correction. On most accidents, you should have many
specific recommendations for corrective action to straighten out
the problems.
CORRECT:
The conditions and casual factors that allowed the accident to
occur is 'the action step of inyestigation. Someone should demand
corrective action to keep this accident from happening again.
Accountability of action is in order. Sometimes corrective action
is not easy to carry out. But if eaqh recommendation is clear,you
can take action to check up on each one of them.
: FOLLOW --THROUGH:
Do not stop. Keep checking and following up on the corrective
action to see of the recommendation was corrected or implemented.
If it is corrected, your investigation is still not finished.
19
CRITIQUE:
In investigations, just like accidents, usually a lot of things are
found wrong. Things can be found wrong with the way the
investigation went, such as initial planning, gathering facts and
analyzing them. In emergencies, these always showup.. .maybe you had
a wrong phone number of a key witness. Now is a good time to
critique the investigation process and take action so the same
things do not happen again.
DOUBLE CHECK:
Nothing seems to get done the way it is supposed to and a double
check is needed to assure every item that specific people were
responsible for and said they were going to do, actually was done.
The same goes for your critique step. Frequently, a triple check or
follow-up. is needed to actually get things done.
SUMMARY:
Many accidents do not justify a very extensive investigation. But
you still must investigate if you want maximum accident prevention
benefit. By following these steps you will do the investigation as
thorougply as possible.
20
EMPLOYER LEVEL INVESTIGATION
Investigate when an injury appears to be questionable, two or more
employees are involved or there is a possible third party. This
could include:
1. Monday morning injuries
2. Off-premises injuries
3. Injuries which are reported late
4. Injuries with unauthorized treatment
5. Injuries where there is a dispute as to the time,place and
manner in which the accident occurred
6. Automobile accidents,generally
7. Special errand injuries
8. Injuries which occur en route to a second job site
9. Injuries which occur while an employee is driving his own car
10. Injuries which occur while an employee is driving to or from
work
11. Injuries which occur while an employee is driving a vehicle
12. Injuries without witnesses
13. Injuries which are reported by very new or short term
employees
14. Injuries which are reported by employees who have several
prior claims
15. Injuries which fall under the five statutory defenses of:
a. INTOXICATION
b. SELF-INFLICTED INJURY
c. INITIAL PHYSICAL AGGRESSOR
d. OFF-DUTY RECREATIONAL ACTIVITY
e. SUICIDE
21
Make inquiries to supervisors.
witnesses and fellow employees.
If appropriate talk to witness and
Ask around for information.
.:
22
CHAPTER VII
AUTOMOTIVE ACCIDENTS
AUTOMOTIVE ACCIDENT PROCEDURES
Every employee driving,in control of,or responsible for any city-
owned motor vehicle involved in an accident (NO MATTER HOW'SLIGHT),
must do the following:
1. Notify the Police Department to respond and make an accident
report. They will be responsible for photographing involved
vehicles.
2. Notify your supervisor.
~
3. Under no circumstances will an employee sign any statements
concerning their involvement in an automobile accident~ You
should report the facts of the accident only to the officer
making the report.
4. The employee will immediately file a detailed written report of
the accident with their supervisor.
5. The Accident Investigation Committee will review all accidents
to determine preventability and responsibility.
6. The Risk Manager will forward the Committee's findings to the
Department Head and the City Administrator for further action.
7. The glove compartment of each vehicle will contain material
relative to procedure for reporting a vehicle accident.
Employee should complete information and return to Risk
Management. Risk Management will issue a new packet for
auto accident reporting.
J
Rev. 12/94
23
ACCIDENT INVESTIGATION COMMITTEE
DATE:
DATE OF ACCIDENT:
TIME OF ACCIDENT:
LOCATION:
EMPLOYEE:
ACCOUNT NUMBER:
DAMAGE:
VEHICLE:
SPECIAL REPORTS:
COMMITTEE:
PURPOSE OF INVESTIGATION:
Review all aspects of incident.
Report all findings and recommendations to the city
Administrator.
AGENDA:
1. Primary cause of accident.
2. Is accident chargeable?
3. will disciplinary action be recommended?
4. -Prevention of future accidents.
\RISKMGMT\AICMTG\SS
:
EXHIBIT F
AIC #
c.
EXHIBIT G
AIC #
ACCIDENT INVESTIGATION COMMITTEE
FINDINGS AND RECOMMENDATIONS
DATE:
DATE OF ACCIDENT:
TIME:
EMPLOYEE:
c.
COMMITTEE:
In reviewing the incident with the Accident Investigation
Committee, the following is submitted for your review:
PRIMARY CAUSE OF ACCIDENT:
ACCIDENT CHARGEABLE:
DISCIPLINARY ACTION:
PREVENTION OF FUTURE INCIDENTS:
Respectfully SUbmitted,
Risk Manager
\RISKMGT\AICFNDS\SS
CHAPTER VIII
SAFETY AND HEALTH ENFORCEMENT
SAFETY AND HEALTH WORK PRACTICES ENFORCEMENT
Safety and health work practices enforcement has as its goal the
elimination of on-the-job injuries due to equipment,materials,
methods used, safety devices,and acts of individual employees.
To accomplish this goal, the department head and supervisor must
make the employee conscious of the importance of safety to the
employee, fellow employees, and City property.
1. The Risk Manager will provide a workers' compensation loss
analysis to each department head on a monthly basis. The
department head will review the report and take whatever
steps appropriate to curtail or eliminate workers' compensation
injuries.
2. In the event of a work related injury,the employee will sign
the Supervisor'S Report of Accident/Exposure acknowledging the
fact that he/she has read the report and agrees/disagrees with
its content. Supervisor will counsel employee on ways the
injury/accident could have been prevented. Employee may submit
a supplemental statement if he/she disagrees.
3. Injury/accident repeaters are employees who have had two or
more on-the-job injuries within the preceding six months.
Safety counseling will be conducted by the department head to
discuss corrective action which may include but not be limited
to:
A verbal reprimand,
A letter of reprimand to the employee,a copy of which will
be placed in his/her personnel file,
Suspension, or
Termination
All recommended corrective action will have prior approval by the
City Administrator and City Council.
Rev. 12/94
24
"
~
CHAPTER IX
OPERATIONS IN THE PUBLIC WAY
TRAFFIC CONTROLS/BARRICADES
Whenever operations are taking place in streets,parkways,sidewalks
or other places where citizens as well as employees may be
endangered, the Supervisor or crew leader on the work site is as
responsible for the safety of the public in this type of operation
as he is for getting the job done. He must spend ample time
before, during and after the work to protect employees and the
public from the hazards created by this work. The following
procedures are to be followed: .
1. If the street work is to be done,preparations will be made for
traffic and pedestrian safety before work actually begins.
2. If traffic is affected by the operation, proper signage will
be used to warn in advance of work area (construction ahead).
Traffic control signs in and around the work area will be
properly placed and maintained through the period when
work or traffic obstructions exist.
3. Signage will be in accordance with the "State of California
Department of Transportation Traffic Manual" and departmental
policy.
4. Where barricades and signs are used overnight, supervisors will
examine work area for proper placement at the end of the
workday before leaving.
5. Lighted barricades or reflectorized cones will be used for
overnight protection.
6. Where traffic must be periodicallY stopped or obstructed by
workers or equipment in the traveled portion of the roadway,
a flagman with protective vest will be used.
7. All workers in or near the roadway will wear reflectiv~ vests
or while at the work site, department issued uniforms.
8. Flagmen will be used to slow or direct traffic where approach
to work area does not provide adequate visibility by drivers.
9~ ftssistance in setting up signage or barricading is available
at any time from the Community Service Department.
25
10. All plates used to cover holes in the street on a temporary
basis will be spiked in place.
11. In any case where streets are significantly obstructed or
closed for any period of time, the Police and Fire Departments
will be notified of the situation and approximately how long
the closure will be in effect. .
PEDESTRIAN SAFETY
1. When pedestrian traffic is impeded by City operations,
barricades, restrictive tape or rope,or other restraint
will be used to protect the public from the work.
2. If pedestrian traffic must be routed into the street,
protection from traffic will be provided by cones,barricades
and signs,if necessary.
3. Holes in the sidewalk or parkway which must be left open will
be covered, whenever possible, along with perimeter protection.
Every possible means of preventing accidental entry into the
hole should be used.
4. Where an unusual situation exists that cannot be easily
resolved,or when personal injury or damage to equipment or
property occurs as a result of operations, contact the
Supervisor immediately.
!
26
~
CHAPTER X
SAFETY TRAINING
Each department has the responsibility of providing on-the-job
training to each employee on the topics that will permit the
employee to do his job safely and efficiently. This training shall
include:
Orientation to departmental and City-wide safety and
work rules.
Procedures for reporting on-the-job injuries
Workers' Compensation process
City requirements for use of vehicles
Reporting of qnsafe Conditions
III addition, specialized training must be offered in the use of
tools and equipment in order to maximize the capabilities of the
equipment as well as to prolong its usable life and to prevent
accidents.
Every employee is expected to request instruction in those tasks or
pieces of equipment with which they are not familiar.
JOB SAFETY ANALYSIS (JSA)
A Job Safety Analysis is a structured outline used to train and
review procedures in a manner that highlights the key points and
hazards in each task. It is recommended that the Job Safety
Analysis be prepared for each special function where many people
are trained regularly to do the job and where serious injury
potential exist.
JOB SAFETY ANALYSIS (JSA)
JOB INSTRUCTION TRAINING (JIT)
A. Definitions:
1. Job Safety Analysis: A procedure that identifies hazards
or potential accidents in each step of a job, and develops
solutions that will even eliminate or guard against
hazards.
2. Job Instruction Traininq: A technique for on-the-job
, instructors when teaching a person how to perform a
particular task.
27
.
B. Job Safety Analysis Procedure
1. Select the job to be analyzed
Priority for selection
a. Frequency of injuries
b. Potential for severe injury
c. Newly established jobs
d. Jobs where changes have been made
2. Break down the job
a. List steps in sequence
b. Not too detailed
c. Not too general
d. Technique of making a JSA
(1). Select the right man to observe
(2). Brief him on the purpose
(3). Observe him performing the job
(4). Record each step in the breakdown
(5). Check the breakdown with the operator
3. .Identify hazards and potential accidents
a. Environmental hazards (mist,fumes,dust,etc.)
b. Potential accidents (s~ip,trip,strain,etc.)
4. Develop solutions to eliminate hazards
a. Change existing conditions
b. Find a new way to do the job
c. Different tools,materials,equipment or location
!
5. The JSA should be developed by the operator and the
supervisor
28
,
C.
Job Instruction Training Procedure
1. Planning the training
a. Inventory present skills
b. Analyze the need for training
2. How to instruct - the four-step method (JIT)
a. Prepare the worker
(1). Put him at ease
(2). Define the job
(3). Place in the correct position
b. Present the operation
(1). One step at a time
(2). Tell and show each step
(3). stress each key point
c. Tryout performance
(1). Have him perform the task
(2). Have him explain each key point
(3). Make sure he understands
d. Follow-up
(1). Put him on his own
(2). Designate to whom he goes for help
(3). Check frequently
(4). Encourage questions
29
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CHAPTER XI
SAFETY REGULATIONS
PRINCIPAL CAUSES OF ACCIDENTS
We can eliminate unsafe actions and conditions, and thereby decrease
the possibility of accidents,by gaining a better understanding of
the common causes of accidents. The following list represents the
ten principal causes of accidents:
Improper lifting
Material handling
Slips and falls
Falling or flying objects
Bumping into stationary objects
Improper tools or equipment
Failure to use protective equipment
Failure to observe rules and instructions
Improper work procedure
Poor~ousekeeping
c.
GENERAL SAFETY RULES
1. Fighting,horseplay and practical joking is prohibited.
2. No work shall be started in any unit,or any equipment, without
the knowledge and consent of supervisor assigned.
3. An employee shall immediately report any unsafe conditions or
practices to his supervisor.
4. All injuries occurring on the job, no matter how slight,must be
reported to the supervisor immediately.
5. Running except for emergency purposes is prohibited.
6. Obey all warning signsithey are there for your protection.
7. Keep working areas clean and in an orderly condition.
Equipment and material will .be ,neatly arranged.
8. Be constantly on the alert for unsafe conditions and report
such conditions to your supervisor.
9. Place air lines,cords,water hose,etc.,so as to avoid
tripping hazards.
10. Keep clear of suspended or swinging loads.
11.
,
When carrying o~ handling material with others,make sure you
understand each other to avoid injury that might be caused by
unexpected shifting or dropping without warning.
30
OFFICE SAFETY
Every employee shall be responsible to see that his own
and work area is clean and orderly. pick up items such
pencils or paper clips and wipe up any spilled liquids.
housekeeping is the key to a safe office environment.
2. Keep an eye open for loose or rough floor covering.'
1.
desk
as
Good
3. Be extra cautious when you come up to a door that can be
pushed toward you. Take it easy when pushing one open and
slow down when coming to a blind corner.
4. Haste when walking between desks results in bruises and falls.
Watch out for electrical and telephone cords and keep them out
of aisles. Electrical and telephone cords should~ot be
under plastic floor mats.
S. All file, desk and table drawers shall be kept closed when not
in use. As soon as you leave them, close them. Never open
more than one file drawer at a time.
6. Overloading the top drawer or opening two drawers at the same
time of unsecured file cabinets has caused many an injury and
damage. If unfamiliar with the file cabinet, test the drawers
and be careful not to pull them out too far if there is no
locking device on them.
7.
Furniture such as tables, desks and chairs must be maintained
in good condition and free from sharp corners projecting
edges, wobbly legs, etc.
8. Tilting chairs can be a hazard when improperly used and care
should be taken to assure that they are in good condition.
Learn the limits. Be sure your chair is behind you before
you sit down.
9. Never use chairs, desks or other office furniture as a
makeshift ladder. Use a step iadder. Do not overreach
and lose your balance.
. 10. Message spindles are a frequent source of puncture wounds to
hands and other parts of the body. When used, the point shall
be protected by a suitable blunt cover, or preferably,the point
should be bent at a horizontal angle.
11. Keep the blades of paper cutter closed when not in use.
;
,
!1? Pencils are safest when carried point down in pockets.
31
13. Scissors,paper cutters,glass and razor blades can cause
painful injuries. Report such injuries at once and take
precautions from infection.
14. Keep your hands clear of electric typewriter carriages
while they are in motion.
15. Paper can cut and it hurts. Use a sponge or other wetting
device for envelopes. Use rubber finger guards when working
with stacks of paper.
16. Keep paper clips, thumb tacks and pins in a place where they
cannot injure you. Keep razor blades or exacto blades
covered. Even a little scratch can get infected.
17. Be sure equipment is grounded and the cord is in good
condition. If a machine gives you a shock or starts
smoking,unpluq it and report it.
18. The city' of Vernon maintains a non-smoking policy in the
work environment.
19. Hot plates are not permitted.
CLOTHING AND SAFETY EOUIPMENT
1. Employees shall dress suitably for the work in which they are
engaged. Wearing apparel that may contribute to injury or
disability shall not be worn.
2. Employees shall not work with bare head,bare arms or exposed
body parts in areas where they may'be exposed to burns from
corrosives,hot substances or hot equipment.
3. Minimum requirements for work shoes are substantially
constructed shoes. The wearing of moccasins, tennis shoes,
house slippers, thongs, etc. will not be permitted. Work boots
are mandatory where fqot hazards are apparent.
4. Certain working conditions and areas require the use of
protective equipment, such as respirators, gas masks, face
shields, goggles, etc. An employee so engaged shall use
such protective devices and special wearing apparel as
may be required.
5. Employees must be familiar with all protective devices and
wearing apparel that they may be required to use. They shall
make certain tha~ such equipment is in good condition and
adequate before it is used.
32
6. The proper type of goggles and face protection shall be used
by employees while performing any of the following duties:
a. Operating pneumatic tools.
b. Using a hammer or other tools to remove scale,rust,paint,
cinder, dust, etc.
c. Using wire brushes or other tools to remove scale, rust,
paint, cinder, dust, etc.
d. Using a grinding,polishing or burnishing wheel.
e. Sandblasting,paint spraying or power sanding.
f. Handling acids,hot liquids, caustics, or other c?rrosive
substances. ~
g.Working around machinery or equipment where loose
particles will endanger the eyes.
h. Welding and cutting.
7. Contact lenses present a hazard to employees working where
chemicals, acids, solvents or any foreign particle enters the
eye. An employee who wears contact lenses in areas where
these hazards exist is required to wear goggles.
8. All employees using hazardous chemicals,etc must be familiar
with location and use of eye wash equipment.
TOOLS AND EOUIPMENT
1. Tools shall be kept in good condition and free from grease.
2. Tools shall not be thrown,dropped,laid on moving machinery,
or left lying around when not in use.
3. Use the proper tool for the job.
4. When tools break,wear out or otherwise become dangerous to
use, they will be replaced.
5. Keep impact tools free from mushroomed heads.
6. Power machinery and power tools shall be operated only by
employees who are properly trained and assigned such duties.
,7 All machinery and power tools shall be operated within their
respective load and speed limits.
33
8. Power shall not be turned off or on without proper warning
and caution to see that no person is exposed to danger.
9. No employee will ride a load or the blocks of any hoisting
device.
10. Machinery guards shall be in place and properly adjusted
before and while machinery is in motion. Missing or defective
guards shall be reported immediately.
11. Machinery shall not be cleaned, adjusted or repaired while in
motion.
12. Machinery and power tools shall be properly grounded.
MATERIAL HANDLING
1. Do not try to lift objects that are bulky or too heavy to lift
comfortablYisecure help.
2. Use the following technique to lift:
a. Get a firm footing.
b. Bend at the knees to grasp the object.
c. Keep the back straight and as nearly upright as possible.
d. Get a firm hold on the object.
e. Lift gradually by straightening the legs,keeping the back
straight and upright.
f. Similar safe procedures will be followed when putting a
load down.
3. Use power assist equipment where possible when material must
be moved.
4. Store material in such a manner as to prevent collapsing or
tipping.
5. Loads on forklifts,trucks,etc.,shall be stable to prevent
skips,slides,or tip overs.
6. Material will not be stored on top of lockers.
7. Use proper tools when opening boxes,barrels or other
containers.
Rev. 12/94
34
ELECTRICAL
1. Electrical work and repairs will be done by trained employees
only.
2. Electric cords will not be spliced.
3. Circuits shall not be overloaded.
4. Fu~es shall not be wired across,plugged,or replaced with
higher amperage fuses.
5. Electrical equipment or lights shall not be altered except by
authorized personnel.
6. All electrical equipment shall be properly grounded.
7. No material or equipment will be stored or placed within 30
inches of any electric panel or controller.
HOUSEKEEPING
1. Good housekeeping is essential for efficient operation and
prevention of accidents.
2. All areas will be kept clean and free from trash and
accumulation of waste materials.
3. Trash receptacles will be used and emptied regularly.
4. Scrap metal will be placed in separate but appropriate
containers.
5. Oil-soaked rags will be kept in containers with tight-
fitting lids.
6. containers will be labeled as to what they contain.
7. Floors,working areas,and platforms shall be kept free of
dangerous projections or obstructions and shall be maintained
in good repair and reasonably free from oil.
8. Proper cleaning material and methods shall be used for the
task.
9. Gasoline or other volatile liquids shall not be used for
cleaning purposes.
Rev. 9/95
35
AUTOMOTIVE
1. Movement of various pieces of mobile equipment and vehicles
in and around shop areas require adherence to all motor
traffic regulations.
2. All traffic signs, signals, speed limits, and road markings shall
be obeyed.
3. Seat belts, will be worn at all times when riding in or
operating any vehicle.
4. Operators of motor vehicles will have a current operator's
permit in their possession for the vehicle being driven.
This does not apply to a mechanic who must move a vehicle to
and from parking areas to repair bays. However, supervisors
will insure that the mechanic is qualified to operate the
vehicles.
5. Courtesy and consideration is expected of all employees while
operating motor vehicles.
PORTABLE LADDERS AND WORK PLATFORMS
"
1.
Inspect all ladders and work platforms before using them.
Report any defects to your supervisor immediately.
2.
Makeshift ladders or work platforms will not be used.
3.
When necessary to work overhead, use a ladder or work platform
of sufficient length or height to be able to reach your work.
Work platforms of 30 inches or higher will be provided with
hand and guardrails.
Metal ladders will not be used for electrical work.
4.
5.
6.
Metal ladders will be labeled with a warning, "Do Not Use For
Electric Work. II
7.
Never use a ladder without safety feet suitable for the floor
or ground it stands on. Exception: Stepladders.
Ladders shall be placed so that the base is placed from
the wall or object 1/4 of the vertical distance from the
bottom to the top support of the ladder.
8.
9.
.
,
Never place a ladder on another object such as a barrel or box
to gain added height.
Rev. 9/95
36
10. Tie or secure the ladder at the top where possible, and either
tie or brace it at the bottom.
11. Be sure your shoes are not greasy, or otherwise slippery before
you climb a ladder or work platform. When climbing or
descending, face the ladder and use both hands. Do not reach
out more than an arm's length ladder.
12. Never work from the top rung of ladder.
PNEUMATIC TOOLS AND LINES
1. Use of compresssed air on or about your body or the body of
any person is forbidden.
2. Use of compressed air or gases for blowing dust or chips from
your body,clothing or work area is prohibited.
3. Attach air hoses only to compressed airlines.
4. Hoses shall be kept neatly coiled, when not in use,to prevent
tripping hazards.
5. Turn off valves on airlines and tools when not in use.
6. Wear eye protection when using pneumatic tools and when
cracking or opening valves.
7. Frequent inspections will be made of all air lines and their
connectors to insure that they can withstand the pressure.
Defective air lines and connectors will be removed from
service.
8. Wear ear protection when required.
BURNING AND WELDING
1. Oxy-Acetylene Equipment
a. Only authorized and properly trained personnel will be
permitted to install or remove special fittings on oxygen
and acetylene cylinders.
b. Oxy-acetylene equipment shall be used only by authorized
employees.
c. Extreme caution shall be observed when handling oxygen
and acetylene cylinders.
d. Safety caps will be securely in place on all compressed
gas cylinders when not in use.
37
*
e. Gas cylinders shall not be moved by means of magnets or
slings.
f. Gas cylinders shall be used or stored in a vertical
position and securely fastened to prevent them from
tipping over or falling.
g. Oxygen and acetylene cylinders will be stored at least 20
feet apart.
h. Oxygen and acetylene cylinders will not be stored where
they are subjected to unusual heat sources or oil and
grease.
i. Empty cylinders shall be returned to their proper storage
area.
j. Cylinders and personnel shall be protected from sparks
and slag.
k. When burning or welding, make sure that sparks and flames
will not start a fire in nearby material.
I. Excess hose lengths will be coiled or arranged to prevent
tripping hazards.
~
m. When working overhead, enough hose will be used so that
cylinders may be kept on the ground or other secure
location.
n. Welders shall wear eye,face,hand,respiratory,foot and
body protection as required.
o. Welding will not be done in confined spaces without
adequate ventilation or an approved type respirator.
2. Electric Welding
a. Welding will not be done without a shield fitted with
filter glass of the proper shade.
b. Never look. at a welding arc with the naked eye.
c. Welding screens or shields shall be set up between
welders and other employees.
d. Eye protection shall be worn when chipping, scaling,
and peening.
Rev. 12/94 38
e. Material to be welded and all components including the
welding machine will be adequately grounded to a common
grounding system.
f. The safety ground attached to the welding machine or
transformer will be connected to "ground" before
equipment is energized.
CHEMICALS
1. Extreme care shall be exercised by all personnel handling or
working with acids, caustics, solvents, petroleum products,or
chlorine.
2. In mixing acid and water,always pour the acid into the water
slowly. Never pour the water into the acid.
3. Handle tools carefully while working around acid or other
chemicals to avoid dropping them where they may cause a
splash.
4. After tools have been used near corrosive chemicals, clean them
thoroughly by neutralizing with lime baking soda.
"\
5.
Wear protective goggles,respiratory equipment, and protective
clothing when the inhalation of fumes or hazardous substances
or injurious bodily contact with acids or other corrosive
materials may occur.
6. Wash out eyes with large quantities of clean water immediately
if chemicals splash into them, and report to a doctor or
emergency room immediately.
7. All spilled acids or caustics shall be cleaned up immediately.
Spilled acid shall not be mopped up with organic materials
such as sawdust,waste,or cloth. Use neutralizing agents such
as lime or baking soda. Clean up and properly dispose of
residue.
8. containers of injurious chemicals or hazardous substances
shall be plainly labeled, indicating hazards and precautionary
m~asures to be observed.
9. Only authorized personnel shall use pesticides, herbicides,
fungicides,or any agricultural chemicals having critical
toxicity.
10.
i
.
Rules stating the proper safety equipment required will be
posted at the storage area of chemicals,hazardous substances,
pesticides and herbicides.
\
Rev. 9/95
39
EXCAVATIONS. STREET REPAIRS. SUB-SURFACE OPERATIONS. AND CONFINED
SPACES
1.
The foreman or person in charge of an excavation to a depth of
five (5) feet or more shall see that it is effectively shored
and guarded in accordance with the State Construction Safety
Orders.
2.
Excavated material shall be kept at least one (1) foot from
excavations of less than five (5) feet in depth and two (2)
feet from the edge of deeper excavations.
The foreman or person in charge of an excavation to a depth of
five (5) feet or more shall provide a sturdy ladder for
access. The ladder shall be placed within twenty-five (25)
feet from the working area.
c.
3.
4.
The foreman in charge of an excavation shall see that there is
no work done which could cause the undermining of foundations,
retaining walls,or other structures until adequate safety
measures have been taken.
5.
Excavating machinery shall be kept away from electrical, gas,
and water lines. Where excavation is necessary,the operator
of the equipment shall first determine the location of
electrical, gas and water lines that may be in the area of
excavation,and a qualified observer must be present to guide
the operation.
Only one man should direct the operation of excavating
machinery..
All persons working around excavating machinery shall be in a
safe position so as not to be in danger of falling into or
oth~rwise contacting the machinery.
The foreman or leadman shall make tests in all closed
compartments,manholes,storm drains, tanks, voids, and other
confined spaces for oxygen deficiency, explosive gases,and
other dangerous gases which may be present. Employees shall
not enter such areas until the foreman or leadman has issued
an "all clear". This must be done at each time of entry or
re-entry.
6.
7.
8.
9.
Smoking or open flames'are prohibited in or about open
manholes or sewers. "No Smoking","No Open Flames" signs
shall be posted.
1Q.
'\
Hard hats shall be worn at all times by workers in or around
excavations, trenches, tunnels, sewers, or other sub-surface
operations.
40
11. Employees entering a sewer I storm drain or other confined
space shall be tethered with a life line or harness so that
they can be pulled out in case of emergency.
FIRE PREVENTION
1. Prevention of fire is a responsibility shared by all,
regardless of the type of job.
2. Whenever you suspect or detect a fire, the Fire Department
shall be notified. Use of telephone, Vernon Communication
Center Ext. 351 or 800 and 911 from an outside telephone also
by radio. Calmly report location and extent of the fire. In
addition, priority must be given to the safe evacuation of
personnel from the affected area.
3. If you have followed the preceding procedures and.:have been
trained in the use of available First Aid Portable Fire
Extinguishers,you are encouraged to attempt to suppress a
small fire in the incipient stage.
'\,
4. If you have the slightest doubt whether or not to fight the
fire--DO NOT--instead, GET OUT, closing the door behind you.
Remember, NEVER, jeopardize your safety or the safety of those
around you by attempting to put out a fire.
5. Flammable liquids shall be stored or handled in approved
hazardous locations, cabinets and safety containers only.
6. Keep all flammable liquids or other hazardous materials away
from open flames and other sources of ignition.
7. Practice good housekeeping. without fuel a fire cannot exist.
8. Remove,shield or cover combustible equipment or material that
will be within the range of any activity where open flame,
sparks or hot metal is produced,i.e.,welding,torches,etc.
A fire extinguisher will be available where such work is
performed.
9. Fire fighting equipment shall not be blocked and will.be
easily accessible.
10. Fires are classified according to A,B,C. (Refer to Exhibit J)
\
Rev. 9/95
41
EXHIBIT J
.
Labels on extinguishers indicate the class and relative size of the fire that they can be expected
to handle.
~
.: \
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flA
CLASS A EXTINGUISHERS: Ordinary combustibles. Wood, cloth, paper, rubber, many
plastics, and other common materials that burn easily.
rnlEJ
CLASS B EXTINGUISHERS: Flammable liquids. Gasoline and other flammable l.iquids, oil.
grease, tar, oil-based paint, lacquer and flammable gas.
m@
.:'
CLASS C EXTINGUISHERS: Electrical equipment. Energized electrical equipment,
including wiring, Euse boxes, circuit breakers, machinery .:md
appliances.
~ Before Fighting a Fire
.)
. · Notify Fire Department:
Ext. 351 or 800. F'1:an outside phone. 9ll
· Evacuate Cast Members and Guests from the affected area.
· Stay low. Protect yourself. A void breathing the heated smoke and fumes or the
extinguishing agent.
· Never fight a fire if the fire is spreading beyond the immediate area; if the fire could
block your escape route; if you are unsure of the proper operation of the .
extinguisher; or if you are in doubt if the extinguisher is designed for the type of fire
at hand. . ,
However, if you do fight the fire with a portable fire
extinguisher, remember:
P-A-S.S
~>~
~M /',..~
· Pull the pin
· Aim low
~ Squeeze the handle .
,
"- Sweep from side to side
s
r
~
5
CHAPTER XII
HAZARDOUS MATERIALS
CONTINGENCY PLANS
Emergency response plans and procedures are developed for use in
the event of a release or threatened release of hazardous material.
The State of California Office of Emergency Services (OES)
regulations specify that the contingency plan should be scaled
appropriately for the size and nature of the business, the nature
of damage potential of the hazardous materials handled and the
proximity of the business to residential areas and other
populations. These plans must include the following items:
1. Reporting and Notification:
a. In the event of a spill,release or threatened release,
regardless of size, involving a hazardous material,the
event will be reported immediately to emergency telephone
#911.
b. Dispatch 911 will notify the Fire Department,Police
Department and other relevant departments.
2. Mitiqation:
a. Coincident with reporting, emergency response team members
will immediately commence cleanup and necessary action to
mitigate the release in accordance with their
instructions and the written procedures. A copy of these
procedures is attached to this contingency plan.
3. Evacuation:
a. Should it become necessary to evacuate the facility,the
order will be given via Police and Fire Department
loudspeakers on vehicles.
b. Upon receiving the order tq evacuate, employees will shut
down their machines and immediately proceed to the
nearest exit as directed.
c.~ All employees will report to their supervisors at a
designated location.
4. Emerqency Response Assistance:
a. The members of the emergency response team will stand by
to assist tbe emergency response agency and offer the
benefit of their special knowledge of the facility and
its contents.
42
b. The following employees will stand by to offer technical
advice to the emergency response agency personnel if
necessary:
1. All Department Heads
2. All Supervisors
5. Medical Assistance:
a.
All employees affected by exposure to the hazardous
materials released during the spill or release should be
transported to the White Memorial Hospital,which is the
most appropriate facility for treatment of chemical
related injuries. A copy of the appropriate Material
Safety Data Sheet should accompany the affected persons
to the hospital.
.:'
TRAINING PLANS
The training plan will provide safety procedures in handling
hazardous materials and the procedures to follow in the event of a
release or threatened release of a hazardous material. The
training will be done initially for present employees, for all new
employees and reviewed at least annually thereafter. The training
will take into consideration the position of the employee in terms
of job assignment and responsibility during a hazardous material
incident.
The training program will be reasonable and appropriate for the
size of the operation and the quantity and nature of hazardous
materials handled. At a minimum, the' training will include:
-Methods of safe handling of hazardous materials;
-Procedures for coordination with local emergency
response organization;
-Use of emergency response equipment and supplies
under control of the handler; and
-The City's contingency plan and procedures.
The contingency plan will document the content of the training
program and ensure that the appropriate personnel receive initial
and refresher training.
SUPERVISOR GUIDELINES:
1. Be sure that the training program is consistent with the
extent of the hazards present in the business and the types of
events anticipated.
43
.
2. The required training in safe handling of hazardous materials
will be incorporated into the OSHA Hazard communication
Program.
3. The training will be consistent with each employee's
responsibility. Therefore, considerable training will
be afforded to a number of the City's emergency response team,
while an employee whose responsibility is limited tq knowing
when and how to evacuate will receive only minimal training.
4. A procedure for documenting that both initial and refresher
training has been done will be included as part of the
training plan and provisions to preserve these records
established.
5. Due to the overlap in the OSHA hazard communicatiop training
and emergency response training,both types of training will
be handled together possibly using MSDS to illustrate
emergency response procedures for particularly hazardous
materials. This approach is especially appropriate for
. required new employee training in both these areas.
44
,
f.(;~1)
,,'10
(;:i~ilJ
, '
I.:. ~-.;.. .:
EXHIBIT K
HAZARD COMMUNICATION PROGRAM
CITY NAME:
ADDRESS:
1. PERSON RESPONSIBLE FOR THE HAZARD COMMUNICATION PROGRAM:
2. INVENTORY OF HAZARDOUS SUBSTANCES IS ATTACHED AND ALSO
LOCATED:
3. MATERIAL SAFETY DATA SHEETS (MSDSS) FOR ALL HAZARDOUS
SUBSTANCES ARE LOCATED AT:
AND A COpy OF THE HAZARD COMMUNICATION STANDARD AND' CITY
PROGRAM ARE KEPT WITH THE MSDSs.
4. EMPLOYEES MAY REVIEW MSDSs AND THE STANDARD BY FOLLOWING THIS
PROCEDURE:
5.
MSDSs NOT ON HAND REQUESTED BY EMPLOYEES WILL BE REQUESTED OF
SUPPLIERS WITHIN 7 DAYS BY LETTER.
THE MSDS FILE IS UPDATED WITH NEW INFORMATION AND NEW HAZARDS
IDENTIFIED BY:
ANY NEW HAZARDS WILL BE REPORTED IMMEDIATELY TO
AND AFFECTED EMPLOYEES
NOTIFIED WITHIN 30 DAYS.
6. CONTAINERS OF HAZARDOUS MATERIALS ENTERING THE PLANT WILL BE
CHECKED BY
TO. ASSURE THAT THEY ARE PROPERLY LABELED WITH THE CHEMICAL
NAME OF THE CONTENTS, THE APPROPRIATE HAZARD WARNING AND THE
NAME AND ADDRESS OF THE SUPPLIER OR MANUFACTURER.
7. IN-PLANT CONTAINERS OF HAZARPOUS MATERIALS WILL BE LABELED
WITH THE CHEMICAL NAME AND HAZARD WARNING. EXCEPTIONS MUST
BE APPROVED BY
THE FOLLOWING EXCEPTIONS HAVE BEEN APPROVED:
8. NON-ROUTINE TASKS INVOLVING HAZARDOUS MATERIALS ARE:
PROCEDURES FOR COMPLYING WITH THE HAZARD COMMUNICATION
STANDARD FOR THESE JOBS ARE THE FOLLOWING:
I-.m'A')
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(.:-..\
:.~.;./
..
9.
EMPLOYEE TRAINING IS PROVIDED TO ALL EMPLOYEES AND FOR ALL
EMPLOYEES. THIS TRAINING COVERS THE FOLLOWING AREAS:
A. THE BASIC REQUIREMENTS OF THE HAZARD COMMUNICATION
STANDARD AND THEIR RIGHT TO INFORMATION ON CHEMICAL
HAZARDS.
B. OUR CITY'S PROGRAM TO COMPLY WITH THE STANDARD, AND
PROCEDURES TO FOLLOW TO SEE THE STANDARD, COMPANY PROGRAM
AND MSDSs.
C. HOW TO INTERPRET AND USE THE LABELS ON CONTAINERS OF
HAZARDOUS MATERIALS.
D. THE POTENTIAL PHYSICAL HAZARDS AND HEALTH EFFECTS OF THE
HAZARDOUS SUBSTANCES AND HOW TO USE MSDSs FOR MORE
INFORMATION.
E. HOW TO HANDLE THE HAZARDOUS SUBSTANCES SAFELY AND OTHER
PROTECTIVE MEASURES IN PLACE.
F. WHAT TO DO IN AN EMERGENCY, RELEASE OR OVER-EXPOSURE TO
THE CHEM!CALS. .:.
G. HOW THE PRESENCE OF HAZARDOUS CHEMICALS CAN BE DETECTED IN
THE WORK AREA.
10. THIS TRAINING IS DOCUMENTED IN THE FOLLOWING MANNER:
RECORDS ARE MAINTAINED AT THE FOLLOWING LOCATION:
11. TRAINING CONCERNING NEW HAZARDS (NEW CHEMICALS OR NEW
INFORMATION ON MSDSs) WILL BE PROVIDED WITHIN 30 DAYS AND
DOCUMENTED.
12 . PERIODIC REFRESHER TRAINING WILL BE PROVIDED AND DOCUMENTED AS
FOLLOWS:
13. OUTSIDE EMPLOYEES (SUBCONTRACTORS AND VISITORS). WILL BE
ADVISED OF CHEMICAL HAZARDS IN OUR PLANT IN THE FOLLOWING
MANNER:
~ONTRACTORS WILL BE REQUIRED TO PROVIDE INFORMATION ON ANY
-CHEMICALS USED IN OUR FACILITY AS A CONDITION OF THEIR
CONTRACT.
OUR CITY RELIES ON THE INFORMATION CONTAINED IN MSDSs AS PERMITTED
BY THE OSHA HAZARD COMMUNICATION STANDARD AND DOES NOT PERFORM
~NDEPENDENT HAZARD DETERMINATIONS. REVIEWED AND APPROVED:
,
,
!
SUPERVISOR
DATE
l
\'
.
..-
HAZARDOUS MATERIALS TRAINING PLAN FOR EMPLOYEES
1. All employees have been trained in the contents of the
contingency plan and the emergency plans and procedures.
2. All training will be documented by employee signature on a
training session sign up sheet. This record of training will
be maintained by the supervisor.
3. Refresher training will be done on an annual basis
documented as indicated above.
4. New employees will be trained on both OSHA Hazard
Communication and Hazardous Material Emergency Response
Procedures prior to working with hazardous substances.
This training will be documented as indicated.. above and
reflected in the new employee's personnel record.'
5. Emergency team members will receive special training- in
emergency response procedures. Incident mitigation and
first aid treatment. This training will be documented as
indicated above.
6. Employees who handle hazardous materials will be trained in
the safe handling of hazardous materials, procedures to
mitigate releases or threatened releases of hazardous
materials and other appropriate emergency actions. This
training will be documented.
7. Management and other personnel responsible for in~ident
reporting will receive special training with regard to the
reporting of releases or threatened releases of hazardous
materials. This training will be documented.
Date
. Prepared by:
45
....
c <
..
CHAPTER XIII
EMERGENCY PREPAREDNESS
An emergency/disaster plan describes what the employee life safety
hazards are and what actions the employer and employees must take
in a life/injury-threatening emergency.
The city of Vernon's emergency plan will include the following
items:
1. A statement of the city's emergency/disaster policy,purposes,
authority, responsibility, control measures, and an organization
chart.
2. An evaluation of expected disasters and their ris~.
3. Maps-of,the City's facilities showing locations of equipment, -
medical supplies, fire equipment, shelters, a command center,and
evacuation routes.
4. A list of cooperating agencies and how to contact them.
5. A warning system and the types of signals used.
6. A communications/command center with the home phone number
and other pertinent information for each employee.
7. Shutdown procedures and facility security measures.
8. Policies for handling visitors and other no-employees during
the emergency.
9. Any other item deemed necessary.
46